Ⅰ-Ⅱ期韦氏环弥漫大B细胞淋巴瘤化疗后辅助放疗价值探讨  

Role of radiotherapy in patients with stage Ⅰ-Ⅱ diffuse large B-cell lymphoma of waldeyer＇ s ring in remission after chemotherapy

作　　者：卢珂[1] 朱远[1] 刘建江[2] 刘鹏[1] 张娜[1] 刘鲁迎[1] 罗加林[1] 周宁[1] 

机构地区：[1]浙江省肿瘤医院浙江省放射肿瘤学重点实验室,杭州310022 [2]绍兴市人民医院,312000

出　　处：《中华放射肿瘤学杂志》2017年第2期160-164,共5页Chinese Journal of Radiation Oncology

摘　　要：目的探讨Ⅰ-Ⅱ期韦氏环弥漫大B细胞淋巴瘤（WR—DLBCL）患者化疗达CR后接受辅助放疗对预后的影响。方法收集2005-2013年问浙江省肿瘤医院收治的130例Ⅰ-Ⅱ期WR—DLBCL资料，全部接受至少2个周期CHOP或R—CHOP化疗并达CR。R-CHOP组43例（含放疗25例），CHOP组87例（含放疗76例）。29例接受了单纯化疗，101例接受了放化疗。Kaplan—Meier法计算生存率并Logrank法检验和单因素预后分析，Cox模型多因素预后分析。结果5年样本量为101例。单因素分析显示ECOG评分0、1分的5年OS率分别为95．6％、80．1％（P=0．000），5年DFS率分别为95．7％、75．4％（P=0．029）；单纯化疗、放化疔的5年OS率分别为77．1％、91．7％（P=0．048），5年DFS率分别为77％、87．4％（P=0．037）。Cox模型多因素分析显示ECOG评分均是0s、DFS影响因素（P=0．047、0．003），加用放疗对DFS获益有关（P=0．039），但与Os无关（P=0．133）。结论疗前ECOG评分低的Ⅰ-Ⅱ期WR-DLBCL患者预后较好，对化疗后获CR者加用辅助放疗可能获益，但需进一步开展前瞻性随机对照研究证实。Objective To investigate the impacts of adjuvant radiotherapy on the prognosis of patients with stage Ⅰ-Ⅱ diffuse large B cell lymphoma of Waldeyer＇ s ring （WR-DLBCL） who achieved complete remission （CR） after chemotherapy. Methods Clinical data were collected from 130 patients with stage Ⅰ-Ⅱ WR-DLBCL who were admitted to our hospital from 2005 and 2013. All the patients achieved CR after at least two cycles of cyclophosphamide, doxorubicin/epirubicin, vincristine, and prednisone （CHOP）-based chemotherapy or rituximab plus CHOP （R-CHOP）-based chemotherapy. In the 130 patients ,43 received R-CHOP （ including 25 patients undergoing radiotherapy） and 87 CHOP （ including 76 patients undergoing radiotherapy） ;29 received chemotherapy alone and 101 chemoradiotherapy. The survival rates were calculated by the Kaplan-Meier method and analyzed by the log-rank test. Univariate and multivariate prognostic analyses were made by the log-rank test and the Cox model, respectively. Results In all patients,the 5-year sample size was 101. The univariate analysis showed that patients with an Eastern Cooperative Oncology Group （ECOG） score of 0 had significantly higher 5-year overall survival （OS） and disease-free survival （DFS） rates than those with an ECOG score of 1 （ 95.6% vs. 80. 1%, P = 0. 000 ; 95.7% vs. 75.4% ,P=0. 029）. Patients treated with chemotherapy alone had significantly lower 5-year OS and DFS rates than those treated with chemoradiotherapy （77.1% vs. 91.7%, P= 0. 048; 77% vs. 87.4%, P= 0. 037）. The multivariate analysis by the Cox model showed that ECOG score was a prognostic factor for both OS and DFS （P= 0. 047,0. 003）. Adjuvant radiotherapy was related to improved DFS rather than OS （P= 0. 039,0. 133 ）. Conclusions Stage Ⅰ-Ⅱ WR-DLBCL patients with low ECOG scores have better prognosis than those with high ECOG scores. Patients with CR after chemotherapy may benefit from adjuvant radiotherapy. The conclusions need to be further confirmed by prospec

关 键 词：弥漫大B细胞淋巴瘤/化学疗法 弥漫大B细胞淋巴瘤/放射疗法 预后 

分 类 号：R733.1[医药卫生—肿瘤]